Permit CITY OF TIGARD ELECTRICAL PERMIT
/111 ' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00178
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/22/2009
Parcel: 1S135DD00500
Jurisdiction: Tigard
Site address: No Address
Subdivision: Lot: 0
Project: Young's Funeral Home
Project Description: Temp power installation of 200 amp panel. 4/24/09, adding (1) branch circuit.
Owner: FEES
ALDERWOODS (OREGON) INC Quantity Description Date Amount
BY SERVICE CORP & SUBSIDIARIES, ATTN: 1 ea Temp Services or Feeders - 04/22/2009 $66.85
PROPERTY TAX -9TH FLOOR, PO BOX 130548 200 amps or less
PHONE: 1 ea 12% State Surcharge - 04/22/2009 $8.02
Electrical
Contractor: 1 crt Branch Circuits w /Purchase 04/24/2009 $6.65
ELECTRICAL INNOVATIONS Service or Feeder
22300 S LEWELLEN RD
BEAVERCREEK, OR 97004 -8733
PHONE: 503 - 760 -7267
FAX: 503 - 632 -6564
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $81.52
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days • EN • •. Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 1 -0010 thr•ugh OAR / • ' I e 45 00. You may obtain a copy of the rules or direct questions to OUNC by callin. 503:2 6699 or 1.800.332.2344.
Iss d By: ! ■LA 4 _a _ Permittee Signatur•. %/' r 40!"`""
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicafio>� ° ; ' FOR OFFICE USE ONLY
HI L . rn It �
r
City of Tigard R eceived A
Permit No.: Q
`J g Date /By: y y t-L ! ,5t- /��
13125 SW Hall Blvd., Tigard, OR 974\2A.— 4 2009 Plan Review Other Permit:
' Phone: 503.639.4171 Fax: 503.590 ,' 6 '‘ Date By:
Inspection Line: 503.639.4175 Date Ready/By: luris. ® See Page 2 for
TIGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified /Method: �a Supplemental Information
TYPE O3'G DIViSiON' PLAN REVIEW -
❑ New construction I=1 Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION ' . - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
- _ , JOB `SITE INFORMATION AND LOCATION, :. , _ . .. ❑ Addition of new motor load of ❑ "A ", "F' , "1 - ", "1 -3 ",
Job no.: Job site address: k�7D /al 6 5 Six or or more residential R occupancy. Recreational ❑ Six or more residential units. ❑ Recreatioonal vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: / r amps J y � ' 5 �" �f2q L `�D H � ❑ Service or feeder 600 ams or more. ,, -
FEE SCHEDULE '
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33 40 1
Tax map /parcel no.: / 5 1 3 5 G c 5 _ Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
P
n n ►2 _ �✓1 Limited energy, multi - family 75.00 2
�- `- (..0 �, 2 • C l Cc.t t 1 r , O L17 pPC-r)/ c —W/ 7 ' residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' 'O; PROPERTY' OWNER . ❑ TENANT . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, Rer panel
A. Fee for branch circuits with
APPLICANT . , , ❑ CONTACT.PERSO above service or feeder /
der fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
. " CONTRACTOR T.. . , Sign or outline lighting 53.40 2
Business name: E4_ L C T12 1 Signal circuit(s) or limited -
G ni - L /�✓ JO iJ�'7 - t�� s energy panel, alteration, or
Address: 0 - ' ?�00 6 Let. W L1 -4- /3 extension. Describe: Page 2 2
City/State /ZIP �,,, JV Q eQ e 4 i ,o_ ? 7a)( .. g7 J T j Each additional inspection over allowable in any of the above
' l t Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
_ , ELECTRICAL PERMIT FEES . _ _
Suprv. Electrician signature, required: Subtotal: /
Print name: Date:
Plan review (25% of permit fee): t/ (D
. SO
State surcharge (12% of permit fee): , 8O
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(1 I /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,RESIDENT WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ; ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
P \Building \Permits\ELC - PermitApp doc 03/23/06
q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00178
T 1 GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/22/2009
Parcel: 1S 135DD00500
Jurisdiction: Tigard
Site address: No Address
Subdivision: Lot: 0
Project: Young's Funeral Home
Project Description: Temp power installation of 200 amp panel.
Owner: FEES
ALDERWOODS (OREGON) INC Q uantity Description Date Amount
BY SERVICE CORP & SUBSIDIARIES, ATTN: 1 ea Temp Services or Feeders - 04/22/2009 $66.85
PROPERTY TAX -9TH FLOOR, PO BOX 130548 200 amps or less
PHONE: 1 ea 12% State Surcharge - 04/22/2009 $8.02
Electrical
Contractor:
ELECTRICAL INNOVATIONS
22300 S LEWELLEN RD
BEAVERCREEK, OR 97004 -8733
PHONE: 503 - 760 -7267
FAX: 503 - 632 -6564
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.87
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 th oug OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling $3.246.6699 or 1.800.332.2344.
Issued By: ' +4 QI :�X\A, �� titts Permittee Signature: —� ■- �� \ .11i
-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED .
t •c ift•UrFlt „f.
jectric Pe_ t[nft A lica4on APR 2 2 2009 4 P et e * �° � �
City of Tigard Oth
III er 13125 SW Hal! Blvd. Tigard. OR 972
/i Phone: 503.639.41 Floc: 503.598. OF TIGARD II” em
II " • , B ser rMa z far
4175 B UILDING DIVISION '3 waraY, 4 $nppte1te141 ffAnrrlahna
Intoner Line: S ? -Dr. ; wpri feMerhad
lrtocmat: www.iigard -or. d/ „,:.. t ° iII• • `'`" "F' ' s..:: - . • •
WOW _ r- . � . ... yr,,� y "5... chocked Mow):
1nrP11 OT Meneekeck all that apply (s06mit2 Me orptenr w/ixns
.: `':....�:•.:- =' �:.;:. , - •`. � "� more OBuild;ngovatrcerioriea.
• � Addition/alteration/replacement 0 Service or Seeder 400 pups a 1 ��
• New onion tt;M ❑ n /replacement �� U r where the wettable Saoh C rrem 13 Marina, end booty
Q Demolition rOthcr: /� o ccecds 10,000 afloat so volts or DFla at+ngbuildinge. • • � , ` ; CATEGORY OF IRII r 1em to pound. or wretch 14,000 O Comoro bv4d aerkLla r a
- a : d 2 • el Commercial /industrial ID Accc Spry building amps fur alt other installn6en& g.
r Q 1- and 2-family ❑ � OF� repunrm. [7in�mm�aor75xv�or
r-t bilder Master u • i her: "� f ie�', limn reparatcly derived system.
❑ Multi -family ❑ � Addition of no .riven+ A. F. - •. -. L . 3 -.
'_,,; .)01 silt PIF'ORMA AND LOCATION .. . ' ; •....` 0 nom tc ad of t7 °
100RP w more. occupancy.
�, . o i �v1 rs O 0.aentroonet varcte puke.
lob site address.: t✓ ° �• T• ! 4 0 Si n li more residential unite. (3 Supply voltage for more Than
Job no,: [) 3tcsdrlHrate facilities.
. r p 0litaadou%'ounion•. 600 va1G sentinel.
City /Statd7lP: � 4 � t� 2 ! 1:3 service c. feeder sun onion or more. ., M .• - _ ;, ..
Suite/bldg./apt. no.. Project name: -: t; g:: rr: - :7: .' • twt
Cross Street/directions to job Site: ( C• C -
New residential elngk• or audit- family dwtllieg alit
include atMebod garage. � 4
Lot no.: 5.000 sq. i4 or less,
FL add'1 500 sq. fl. or portion 33.40
Subd ivision: s;dal,tiat Op
Tax map /parcel no.: Limited above a ?. n. 1 .
D� t3>F Limited energy. multi- klrnilY 75.00 13
/� b'� residential violnbare ..9,
, � .2e-‘-c a d'f ^f maces or feeders foutsllano • Mivratioa and /or relocation
200 amps or less n 80.30 �
Q 201 amps to 400 amps.
r 106.85 2
... ?..`7 :�A:;, > :. '; .. .. �; -: �•: � " . .. - - 401 amps to 600 amps n 160.66 Q
Nettle: a ...a. / ^'�• - • J A"` 601 amps to 1.000 areas ` 240.60 — Ell
�p Over 1,000 an M or volts 111111023111111•1
Address: //7_,21 �<< - f�- � � r � • Temporary services ur feeders fnenlhhoo', alteration, andMr
relocation ,
city/Smic!ZiP: 7y � ._./ 4 r' $' ? J ,j z > r 1�, '
( 7 2- 66.es
U r? G J a e Fat: Lr j ' ^7o r 201 amps to 400 n 1 00.30 2
phone: ) /l that ( own which is not 2
Owner peatad4tton: This installation is being made on Ply ,401 aanrp>I to 599 amps 133.75
intender/ for sale. lease. rent, or exchange. ace ording to ORS 447, 449.610, and 701. 405 mat
dreuits- • • allure • • or r:don • • noel
Owner signature: Date: A. Fee for branch circuits svrdi
move Service or feeder fed � 6.65 2
•. ❑ CONTACT PERSON; 1 branch circuit
r- / • M. 9. Fee for branch c; Amts
Business name: p , J f'�+- t�'�"r w ?thou, service or feeder fee. 46.115 2
n E first branch cimik 2
Contact name: C .� -^r E „' f O`� Each add'1 branch 61=4 6.65 Addtccs: It �.�' / .fir. -� 1 a C Pc-- r 4 e.+ Mfecellsrneoas (ar±tieeor feeder mot include.
9 ) 2 . 3. Each manufxNrcd oI r modular 40.90 2
City/Statr IZ1P: d G 7 dsrdfin>z s ervice anllror roesler
2
R ecce :: on ly 66.85
Pump or ;r,Tgntion c 53.40 2 affarEffifirMIIIIIIIIIIMIli E -mail: , / r ;_; S' m or outlier: Pelting S 2 • L1pIp7iRACIOR,' :: s tartaritts) or llinired-
:.::.:': ,;:; ::.:•>':= ::: S St al
Business nen= e G r. ‘ C.-e. :a r a.:. 'L.. ' ■ .I. • cncrgv panel, eiteratton. or 2
/j exlMB10r1. Describe: • -
Address: 2300 S !' e �� "
Each additional Inspection over allowable in argil of the abort
�, ■
.l�Yy - Pa inspection 62.50
Fax: (8.v) te32 - - investigation per Nitta hrmil) 62,50
Phone: ( ) r • - lou
r Industrial plant 73.75 / � < s► �", Lim: 5 parlour EMEWINII Electrical Li (j P1
gttatu �! „i ��- Subtotal:
Stsprv. Electrician signature. required =GG.� ,./✓' pi review (25' /e of Permit foe): ,
Print nem Date' / -a2 —(�
State au li c h27gr (12% of permit fee): _
f �L l/l/1_ TOTAL FEtt.Ml'f FEE: • f:
Authorized signature: I if • it not abound Idrlela to
1149 Pew upl► mists ' perm
Date dips iMer d bas bees sersesS as eonpkte
Print name: • Numba of inspec do s Allowed per pewit.
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